It's critically important that you inform Optum at the time of member discharge or step-down to a lower level of care. Failure to do so will result in delays of reimbursement, and very possibly denial of submitted claims. Reporting member discharge is consistent for all levels of care, including acute inpatient, residential and partial hospitalization. Even if the member was admitted via our streamlined pre-certification process and concurrent reviews are temporarily suspended for your facility, you must always be sure to report every discharge or step-down level of care. Additionally, facilities may be contacted by Optum for intervention or review on an as needed basis, for admissions demonstrating significant complexity and/or recent chronicity.
Data on all ACE-recognized programs is completed on a 12-month look-back cycle each spring. When the data run is completed, we will notify facilities of the status of their ACE-qualifying programs, including whether the ACE Platinum recognition is retained, modified or recinded for one or more of the facility's qualifying programs..
We've listened to your feedback, and we've responded with renewed focus and a retooled Achievements in Clinical Excellence program
Introducing ACE 3.0
ACE 3.0 is a facility measurement and recognition program that acknowledges and rewards facilities for delivering both effective and efficient clinical care for all levels of facility care.
ACE 3.0 - improving on what's good and eliminating the not-so-good
With its quadruple aim, ACE 3.0 now allows for a more specific comparison of facility programs. We will continue to identify Platinum programs within the four condition categories: General Mental Health, SUD Alcohol, SUD Other, and Eating Disorders. And in addition, we will be looking at performance separately in three levels of care: Inpatient, Residential, and Partial Hospitalization.
programs will be
designated as Platinum
|Facility program admissions
will be evaluated in condition
|Facility program performance
will be evaluated separately
by level of care
ACE 3.0 will:
- Deliver more clinically relevant and actionable metrics
- Distinguish between specfic dianostic categories, levels of care and lines of business
- Facilitate determinations that are accurate and more of an "apples-to-apples" performance assessment
The purpose of ACE 3.0 is to recognize and reward facilities accurately for delivering effective and efficient care
ACE 3.0 endeavors to evaluate facilities based upon trends in health care, as well as the feedback we garner from our network providers and facilities. Listening to what you have to say presents Optum with a fantastic opportunity to incorporate your thoughts and innovations into an evaluation program that is better for you, our members and the behavioral health community at large. Using unbiased data that is quantified and compared to both regional and similar program benchmarks, ACE 3.0 is now even better at Identifying variations in practice patterns, which drive increased costs and poor clinical outcomes.
The end result of our collabaoration with facilities will be to improve performance levels where appropriate and to help achieve and maintain Platinum designations for eligible treatment programs.
ACE Platinum status has its benefits
- Streamlining the traditional Clinical Review process resulting in fewer phone calls
- Identifying, recognizing and rewarding facilities that provide effective and efficient care for our members
- Develop and promote transparency of effectiveness and efficiency metrics
- Monitor success metrics for continuous program improvement
For a more in-depth explanation of the ACE Facility program, please explore the links below. And be sure to visit this page frequently for updates and information about our Achievements in Clinical Excellence program.
- ACE Facility Flyer
- ACE Facility Program Description (Coming soon)
- ACE Facility Presentation
- ACE Facility FAQs
- Example Facility Scorecard (Coming soon)
For questions or more information about ACE or your current ACE ranking, please contact us at firstname.lastname@example.org.